Teaching Video NeuroImages: Paroxysmal Dysarthria-Ataxia in Multiple Sclerosis

A 20-year-old man presented with vertigo followed by hourly episodes of dysarthria and incoordination lasting 5–20 seconds (video 1). Neurologic examination was normal between episodes. The only brain/spine MRI lesion in the right superior cerebellar peduncle (figure, A). CSF analysis revealed elevated white blood cells (6/?L [normal, 0–5]) oligoclonal bands (?4). Paroxysmal dysarthria–ataxia associated CNS demyelination diagnosed resolved oral acetazolamide 250 mg twice daily. Subsequent brain spine B) confirmed multiple sclerosis. arises from ephaptic transmission within midbrain or sclerosis lesions may respond to carbamazepine acetazolamide.1 It should be distinguished genetic contactin-associated protein-like-2 (CASPR2) immunoglobulin G–associated episodic ataxia.2